News briefs and information from Federal agencies and Capitol Hill on government activities, legislation, and grants of interest to the telemedicine, telehealth, and health IT community. Edited by Carolyn Bloch.

Without usable systems, doctors, medical technicians, nurses, administrative staff, consumers, and other users can’t benefit from the potential benefits of the features and functions of EHR systems. ONC is collaborating closely with NIST and other agencies to develop health IT usability standards and measurements and want to see a common sense approach to usability issues discussed.

As Dr. Mostashari, explained, very often designers and vendors do not go into depth or have discussions with the buyer on the issue of usability before the system is purchased. Most people buy equipment only after seeing a slick demo on the product and therefore don’t have enough information on what they have just purchased.

In many cases, the seller very often has more information than the provider buying the product. In addition, when companies purchase the larger systems, usually the Chief Medical Officer doesn’t necessarily pick the product since the final decision is usually up to the Chief Financial Officer.

To pinpoint the need for more usable EHR systems, David Brick M.D a pediatric cardiologist discussed the usability factors needed by the specialized pediatric population and their doctors. Dr Brick pointed out that the information in an EHR used for pediatric cardiac patients very often differs greatly from the information needed for adult care.

As he explained, pediatricians have to deal not only with pediatric care versus adult care, but they also they treat the fetus, neonates, and adolescents, along with their usual pediatric patients. They often see all of these categories of patients in one day and not always only in their offices. They have to be in touch with urgent care facilities, emergency rooms, ICUs, and operating rooms. This further necessitates the need for accurate medical data to be available through a reliable EMR system that can provide data in every medical situation.

He discussed in detail how the growth chart in an EMR is such a critical component for any pediatric chart so that medication overdoses do not occur. An average baby can weigh from nine to twelve pounds at birth while the average length of an infant is usually about eighteen inches.

As Dr. Brick noted, there can be considerable differences in just the matter of weight changing with newborns. During the first week of life newborns can lose weight but the length does not usually change during that week. However, the newborn’s change in weight during the first week can greatly affect dosing issues. Therefore, information from the growth chart needs to be accurately documented and easily available in the medical record.

The FCC on May 24th adopted rules to enable Medical Body Area Networks (MBAN), a low-power wideband network consisting of multiple body-worn sensors to be capable of transmitting patient data to a control device. MBANs provide a cost effective way to monitor every patients in a healthcare institution.

MBAN devices are being designed to be deployed widely within a hospital and will make use of inexpensive disposable body worn sensors. The technology also makes it easier to move patients to different parts of the healthcare facility for treatment and gives healthcare providers the chance to identify life threatening problems or events before they reach critical levels.

All MBAN use of the 2360-2390 MHz band at healthcare facilities will be subject to registration with an MBAN coordinator and additional coordination if warranted by locations. Use of this 30 MHz will be restricted to indoor operation at healthcare facilities.

The FCC order has allocated bandwidth at 2390-2400 MHz for MBAN use for other locations. It will accommodate MBAN use through an expansion of the existing Medical Device Radiocommunication (MedRadio) Service in Part 95 of the rules. This structure will permit MBAN devices to operate on a license-by-rule basis in which users will not have to apply for individual station licenses.

The Philippines Department of Health, Tarlac Provincial Health Office, and Qualcomm Incorporated through its Wireless Reach™ initiative, has expanded their “Wireless Access for Health” (WAH) project that uses 3G wireless technology to improve healthcare. Local Tarlac government officials are going to support the replication of the project across the entire province by the end of 2012.

The WAH builds upon the existing community Health Information Tracking System (CHITS) developed by the University of the Philippines, Manila. Since 2009, WAH partners have established CHITS as their own EMR platform and increased the use of the system from just four rural health units to 21 health clinics in the Tarlac Province and serving more than 1,500 patients a day.

As of April 2012, more than 109,000 patient consultations have been captured by the system. The Tarlac Provincial government has replicated the project in all 38 health provincial clinics which makes Tarlac the first and only province in the Philippines to have all of their health clinics interconnected and running on a health information system.

The expansion of the WAH project also includes doing province-wide pilot testing for the “Mobile Midwife” and “Synchronized Patient Alert via SMS” (SPASMS) applications. “Mobile Midwife” enables data to be captured electronically during patient visits via smart phones, tablets, or laptops, and instantly sends patient data to the CHITS systems. To date, 26 midwives are participating in the program and 1,100 SPASMS have been sent to 250 patients.

In another advancement, Medical Tactile Inc (MTI) with the support of the Pre-Mammogram Foundation, and Qualcomm Incorporated have collaborated to develop a pre-commercial Sure Touch™ Wireless system using 3G enabled tactile sensor technology for breast cancer screening.

The system can detect masses as small as 0.5cm by using tactile sensor technology also known as stress elastography to measure the reactive pressures generated by cancerous tissue, which can be more than 100 times harder than normal tissue.

The system is a small, easy-to-use device consisting of a 3G enabled sensor, touch screen display, and the Sure Touch network. After the images of the tissue are collected by the clinician, a Bluetooth wireless module provides two way communications between the sensor and display so that the clinician can collect the data.

When the clinician is finished performing the exam, the data is automatically uploaded to the network. Centralized servers on the network receive and process the data so that the clinician can access the information using a web browser.

The Sure Touch system has been cleared by FDA for documenting the Clinical Breast Exam in the U.S and is already being used in China, India, Turkey, and sixteen other countries as a screening tool for breast cancer.

President Obama on May 23, 2012 issued the Executive Order “Streamlining Service Delivery and Improving Customer Service” requiring that each major Federal agency make two key government services available on mobile phones within the next 12 months. By next spring, the American people will be able to access dozens of additional government services on their mobile phones for the first time.

The Administration is also ramping up efforts to make large amounts of government data more easily accessible so that entrepreneurs will be able to develop innovative new services and mobile applications that can take advantage of the data.

The Open Data Initiatives program will speed and expand the release of government data in machine-readable form in the areas of healthcare, education, energy, and public safety and will actively stimulate of the creation of new apps and services by entrepreneurs.

In conjunction with the launch of these programs, Chief Technology Officer Todd Park has announced a new “Presidential Innovation Fellows” program. This initiative will bring in top innovators from outside government for focused tours of duty to work with Federal innovators to create new projects.

The Office of the National Coordinator for HIT announced that the i2 “Ocular Imaging Challenge” is available. The Challenge is looking for developers to create an application that will improve interoperability among office-based ophthalmic imaging devices, measurement devices, and EHRs.

Documenting the typical ophthalmology exam in an EHR continues to be difficult and creates barriers to full acceptance and the use of EHRs within the medical community. Ophthalmologists use an array of measurement and imaging devices during exams that produce data and images in numerous forms.

However, the data and images are often stored in databases and file formats that have limited connectivity with EHR systems, ophthalmology specific picture archiving, and communication systems. This Challenge is a multidisciplinary call to innovators to create an application that can solve the problem.

The first place team will win $100,000 with awards for $35,000 and $15,000 going to the second place and third place teams. Submissions are due on November 9, 2012.

Open Source Electronic Health Record Agent (OSEHRA), a nonprofit organization working to accelerate healthcare IT, has made Janus 4.0 software available. Janus 4.0 is an open source web-based application that gives clinicians a common real-time view of patient information from multiple EHR systems available from both VA and DOD so that clinicians are able to see the information in one integrated view. The Hawaii Resource Group LLC developed Janus 4.0 and provided the open source license for the software.

Janus originated as part of a DOD/VA interoperability program launched by the Pacific Telehealth & Technology Hui and was also supported by the Pacific Joint Information Technology Center both formed by Senator Daniel K. Inouye from Hawaii.

The Department of Veterans Affairs and DOD have deployed the Janus user interface at the VA Pacific Islands Health Care System, Tripler Army Medical Center and clinics at the James A. Lovell Federal Health Care Center, a joint medical facility in North Chicago.

“Enabling broad access to innovative clinician-facing applications is critical to the evolution of EHR technology,” said Dr. Seong Ki Mun, CEO of OSEHRA. “Making Janus available to the open source community is an important part of that effort.”

For more information, email Seong K. Mun, PhD, President and CEO, OSEHRA at munsk@osehra.org or call (571) 858-3205.

A note sent by Matthew Portnoy PhD, NIH SBIR/STTR Program Coordinator reports that the Central Contractor Registry (CCR) is going away soon and the government is transitioning to a new system. Currently, all companies must register in the CCR before they can apply for NIH’s and likely other agency’s grant or contract funding opportunities. CCR registration is a prerequisite before you can register at grants.gov and at the NIH eRA Commons.

At the end of July 2012, CCR services plus Federal Agency Registration (FedReg”, Online Representations and Certifications Application (ORCA), and the Excluded Parties List System will be migrated into the new “System for Award Management” or referred to as SAM.

With the new SAM, vendors will be able to log into one system to manage their information in one record, with one expiration date, and through one streamlined business process. Federal agencies will be able to look in one place for entity pre-award information. Everyone will have fewer passwords to remember.

Vendors do not need to do anything right away but when it is time to renew your current CCR registration then you will need to register in SAM. You will go to SAM.gov, create a simple SAM user account, and follow the online instructions to validate and update your information. The data that is currently in the system will be migrated from CCR into SAM.

Wednesday, May 23, 2012

The California Health and Human Services Agency (CHHS) announced that the Institute for Population Health Improvement (IPHI) operating as part of the UC Davis Health System, will now implement the states HIE program. CHHS will work in partnership with Cal eConnect to transition HIE programs to IPHI while the state remains the grantor.

Cal eConnect Board determined that as a start-up with a large board, they were not able to move fast enough to implement approved programs. It was recommended that in the best interest of the state, an organization with more experience should continue to implement the HIE programs.

The Office of the National Coordinator for HIT, CHHS and the Cal eConnect Board all support the transition to IPHI as IPHI brings experience in implementing programs and managing complex federal and state grants.

The programs will be under the direction of Kenneth W. Kizer, M.D., M.P.H., who heads IPHI and has a long history of public and private experience in the areas of health information exchange and technology.

IPHI will focus on populations large and small. These populations may be defined by governmental jurisdiction, geography, race, ethnicity, age, occupation, health condition, or other characteristics. IPHI will pay particular attention to the populations of inland northern California and to California in general but also pay attention to the larger global community.

The purpose for the NCCTS grant program is to develop and maintain a collaborative National Child Traumatic Stress Network (NCTSN). Funding is anticipated to be $5 million for NCTSI and $1 million for data analysis and reporting activities.

The purpose is to coordinate national child trauma education and training efforts for children, adolescents, and families who experience or witness traumatic events and need to have access to effective trauma treatment and services. Children of deployed military personnel have more school, family, and peer-related emotional difficulties in comparison to national samples.

NCTSN will have three categories of centers. These centers include the National Center for Child Traumatic Stress (Category I), Treatment and Service Adaptation Centers (Category II), and Community Treatment and Services Centers (Category III). The goal is to develop a public health approach to trauma in order to strengthen surveillance, prevention, screening, and treatment to support trauma-informed systems.

Applicants eligible to apply include state and local governments, AI/AN Tribes and tribal organizations, public or private universities and colleges, and community and faith-based organizations.

Applications for the “National Center for Child Traumatic Stress-(Category I) (SM-12-005 grants are due June 20, 2012.

The Indian population of one billion people is growing at a rate of 1.6 percent per year with the healthcare market expected to reach over $75 billion in 2012. There is rapid growth with middle-income consumers which is creating a demand for a higher standard of healthcare. Many in this consumer segment are looking for international quality medical services to be provided in private super specialty hospitals.

Both the government and private sector are planning new hospitals as well as upgrading existing hospitals. It is projected that India will need at least 80,000 hospital beds per year for the next five years to meet the expanding local demand which means that Indian hospital facilities will need to import high-end medical equipment.

The demand for medical equipment is expected to reach over $5 billion in 2012. In India, imports account for over 65 percent of the entire medical equipment market with approximately 85 percent of the equipment coming from the U.S.

India is going in other directions. In an address recently delivered by the Ambassador of India Nirupama Rao at Emory University on India-US Strategic Relations, she reports that India is establishing the country as a hub for clinical research which may significantly reduce the lab-to-market time for U.S, companies.

She also reports that U.S. firms such as Pfizer and Abbott are working with Indian drug companies to expand their footprint, while Indian companies are looking to move up the value chain by investing and performing R&D.

In May, Secretary of State Hillary Clinton met with Science and Technology Minister Sh. Vilasrao Deshmukh to develop further cooperation in the field of Science and Technology (S&T). The Stanford-India Biodesign Program supported by the Department of Biotechnology and the Indo-U.S. S&T Forum in cooperation with Stanford University, AIIMs, and IIT-Delhi has been very successful. So far 25 individuals have been trained to identify major healthcare needs and are working to find cost effective solutions.

Lockheed Martin has established the “India Innovation Growth Program”. The program is jointly funded by India’s Department of Science and Technology (DST), the Indo-U.S. Science and Technology Forum, the University of Texas TC3 Institute, and the Federation of Indian Chambers of Commerce and Industry (FICCI).

The program’s goal is to launch India’s early stage technologies into the global marketplace. The program is open to all Indian researchers, inventors, entrepreneurs, and companies with early stage technologies showing commercial potential. The technologies are in biotechnology, communications, computing, electronics, information technology, manufacturing, medical, life sciences, nanotechnology, plus a number of other fields.

India is also involved in some joint efforts with other countries. For example, India and Taiwan are interested in receiving joint science and technology research proposals in areas involving micro/nanoelectronics and embedded systems, drug discovery, and biomedical devices with other areas also being supported. The program is open to scientists and engineers in India and Taiwan engaged in advanced research. The proposals must be received by August 30, 2012. For information, email Shri R K Sharma at Sharma_rk@nic.in.

In another Call for Proposals, the Indian Department of Biotechnology and the Danish Council for Strategic Research are requesting research studies directed towards the human aspects of health science biotechnology. Areas for study include research on stem cells and cell therapy, lifestyle diseases, biotechnology perspectives of traditional medicine, cancer, vaccines, and diagnostics. Proposals are due September 14, 2012. For information, email Daniel Skjold Pedersen at dsp@fi.dk.

The rate of immunization for newborns in the Bangladeshi town Habibganj rose from 60 percent to 85 percent in 2010 thanks to a new mobile phone strategy developed by Bangladesh’s health officer Dr. Amjad Hassain. For his efforts Hossain was awarded the “Vaccination Innovation Award for 2011 from the Bill and Melinda Gates Foundation with $250,000 in prize money.

The problem in Bangladesh is that it is sometimes difficult to vaccinate all babies at one month. As it turns out, many babies and children in previous years weren’t being registered for four to five months after birth and this resulted in shots not being given on time. Today, vaccinators have mobile phones that they use to track down pregnant women and parents of newborn babies until they are a year old.

Dr Hassain studied the routine immunization programs in two Bangladeshi districts with low immunization rates. He was tasked with immunizing more than 150,000 children against vaccine preventable diseases including diphtheria, pertussis, tetanus, polio, and measles. In one year’s time, by using mobile phones there was an increase in immunization coverage by more than 15 percentage points

In another project to help the vaccination program in Bangladesh, the Johns Hopkins Bloomberg School of Public Health announced that Alain Labrique, PhD and Director of the Johns Hopkins University Global mHealth Initiative was a Bill & Melinda Gates Foundation Challenges Explorations winner for his mTIKKA, a “Virtual Vaccine Registry” research project.

Labrique is going to do further research on “mTIKKA” to develop a mobile cloud system that will be able to help doctors achieve world-wide vaccinations by dispensing vaccine scheduling information.

mTIKKA is designed to focus on the poorest and hardest-to-reach segments of the population. The aim is to identify in real-time regions where vaccine coverage is limited and to permit community-based targeted interventions aimed at increasing immunization coverage.

Labrique and his colleagues at the JiVitA Maternal and Child Health Research Project while working in close partnership with the government of Bangladesh Ministry of Health and Family Welfare and social enterprise partner mPower-Health have also been actively studying the emergence and impact of mobile phones as part of a complex rural health ecosystem.

The researchers are going to pilot test mTIKKA in rural and remote areas in Bangladesh where vaccination coverage is 44 to 60 percent lower than the national average. The researchers will use an electronic, cloud-based system for infant enumeration and registration, vaccination record keeping incentivizing, and provide interactive knowledge on the vaccination program.

In the future, mTIKKA will provide an alternative to tradition record keeping by allowing parents, providers, and vaccination workers access to immunization records 24/7 wherever needed by using simple technology.

Phoenix Cardiac Surgery of Phoenix and Prescott Arizona have agreed to pay HHS a $100,000 settlement and take corrective actions to implement policies and procedures to safeguard protected health information for their patients.

The settlement with the physician practice follows an investigation by the HHS Office for Civil Rights (OCR) for potential violations of HIPAA privacy and security rules. The OCR’s investigation reported that the physician practice was posting clinical and surgical appointments for its patients on an internet-based calendar that was publicly accessible.

2012 is just the beginning for tremendous growth in the Healthcare Unbound products and services market. Be a leader in this market trend and find out how to effectively meet the needs of this growing evolving market and gain expertise on how to leverage technologies to improve health outcomes and reduce costs. To learn how to execute new profitable ideas be sure to attend the Ninth Annual Healthcare Unbound Conference and Exhibition to be held July 19-20, 2012 at the Hotel Kabuki in San Francisco California.

The Conference will offer not only timely and practical information but also visionary perspectives. Over the years, the Conference has attracted hundreds of high-level executives and clinicians from across the U.S and abroad.

To meet the enormous needs in this field, the Annual 2012 Conference is targeted to:

Consumer technology companies, including consumer electronics, telecom, wireless, and communication technology companies as well as their partners and suppliers

Pharmaceutical, medical device and diagnostics companies as well as contract research organizations

Health plans and employers

Home builders, financiers, security analysts, consultants, and government officials

To meet the needs for a dramatically changing traditional healthcare delivery system, Healthcare Unbound is also attracting a range of companies that previously have not been deeply involved in healthcare such as consumer electronics, telecom, gaming, fitness, and IT companies just to name a few.

Keynote presenters will highlight their newest and greatest ideas related to all the new unbound technologies that are here today or coming in the near future. A partial list follows:

Torben Nielsen, VP eBusiness Strategies and Services for The Regence Group

Chuck Parker, Executive Director, Continua Health Alliance

Many more important speakers and panels to be announced…Stay tuned

Conference attendees will hear vital talks and discussions on such topics as accountable care, reimbursement, regulatory developments, emerging business models, health consumer engagement and behavior change, technology to apply to Baby Boomers and Seniors, emerging wireless applications, the patient centered medical home, technologies used in home care, how to create linkages between EHRs and consumer-facing technologies such as remote monitoring and social media, along with valuable information on how to leverage technologies to improve the health of underserved populations.

It’s important to note that Sponsorship and Exhibition Opportunities can effectively promote your products and services to key decision-makers at healthcare provider and payer organizations as well as to technology vendors.

Sunday, May 20, 2012

Dr. Farzad Mostashari ONC Coordinator for HIT announced the creation of the Office of the Chief Medical Officer (CMO) and Office of Consumer eHealth. The primary function of the Office of the CMO will be to infuse a clinical perspective across ONC on all activities with clinical implications. A search for both the CMO and a Director for the Office of Consumer eHealth will be undertaken nationally, and postings for both positions will appear on http://www.usajobs.gov/ shortly.

Specifically, the CMO will be involved in safety, usability, clinical decision support, meaningful use policy development, and quality including metrics and measurement development. The CMO will report to the ONC Coordinator and will play a key role in help ONC improve health and healthcare through health IT.

The Office of Consumer eHealth will continue to work on consumer engagement that began in the Office of Policy and Planning. Creation of this new office will enable ONC to expand upon work already underway.

In another move, ONC recently launched their “Reporting Patient Safety Events Challenge” designed to spur development of health IT tools to help report medical errors in hospitals and outpatient settings.

The Challenge was initiated since hospitals are struggling to increase internal incident reporting and are struggling to create effective systems so that their quality and risk management staff can easily complete root cause analyses and follow-up.

In addition, quality and risk management staffs have to issue reports using a paper-based reporting system that can affect reporting frequency and quality. The staff’s energy is spent convincing physicians and nurses to report incidents, fill out forms, and then send the forms to the appropriate agencies. ONC is looking for innovators to participate in this new developer contest to help the healthcare delivery community solve these issues.

Reporting issues could be partially alleviated by developing and deploying an effective software reporting solution. This solution would make it easier for any qualified individual to file a report electronically using Common Formats but allowing for additional elements and narratives. The solution must also allow for the hospital quality and risk management staffs to add information from follow-up investigations, submit reports as appropriate to patient safety organizations, submit reports to states, or to FDA, and then be able to track follow-up activities.

Entries for this contest must be submitted by August 31, 2012 and will be judged by:

·Compliance with AHRQ’s common formats

·Usability and design

·Ability to integrate with EHRs and other health IT data sources

·Ability to apply NHIN standards

The first place winner will receive $50,000, second place prize will be $15,000, and third prize will be $5,000.

Researchers at Wayne State University are working to create the future in metropolitan Detroit. Hongwei Zhang, PhD, Assistant Professor of Computer Science in WSU’s College of Engineering and Patrick Grossman, PhD in WSU’s Division of Computing and Information Technology, recently received $300,000 in grant funding from the National Science Foundation. The funding will be used to build an experimental wireless networking infrastructure for research, education, and application exploration.

The network will have multiple sectors, or cells, using “Worldwide Interoperability for Microwave Access” (WiMAX) a communication technology for wirelessly delivering high-speed internet service to large geographical areas.

WiMAX is part of 4G wireless communication technology and far surpasses the range for conventional Wi-Fi local area networks. “WiMAX is expected to play a major role in areas such as smart grids, smart transportation, vehicular infotainment, healthcare, and community internet access,” Zhang said.

Wayne State is already one of nine institutions nationally already equipped with WiMAX technology funded by NSF with additional funding by the John S. and James L. Knight Foundation and Clearwire Corp. So far, the university is using WiMAX technology to provide internet service to about 750 low income Detroit residents.

WSU’s WiMAX network is going to be connected to NSF’s Global Environment for Network Innovations (GENI) network. Although GENI is an experimental infrastructure, researchers envision that the use of GENI will create new possibilities for future internets.

Also, WSU and the Henry Ford Health System (HFHS), as part of their “Institute for Population Sciences, Health Assessment Administration, Services, and Economics” referred to as INPHAASE, have issued an RFP due July 1, 2012. The funding is to provide seed money to researchers at WSU to provide pilot data that will eventually lead to collaborative publications and externally funded collaborative programs.

INPHAASE is an inter institutional, coordinated effort to bring together and integrate the faculty of WSU and HFHS to do further research on understanding the biological and social reasons that exist for health disparities among populations of differing demographics, including ethnicity, gender, age, and economic status. The researchers will test alternative strategies to overcome the disparities, but also work to develop HIT management systems and perform research that can be used to eliminate disparities.

The core activities of INPHAASE are directed towards disease prevention, management, and health promotion in large urban areas that exist in metropolitan Detroit. The objective is to change individual and population behavior related to health status as well as the behavior of healthcare systems and providers.

The focus of this year’s INPHAASE competition is Cancer. The successful proposal will accelerate research in cancer prevention, cancer epidemiology, behavioral research and cancer control, observational studies, comparative effectiveness research all related to cancer and/or cancer health disparities.

On May 17th, FCC Chairman Genachowski was joined by GE Healthcare and Philips Healthcare at George Washington University Hospital in Washington D.C. to announce that the FCC is going to consider new rules at the Commission’s meeting this week. The objective is to allow greater use of spectrum for “Medical Body Area Network” (MBAN) devices to help spur innovation and the development of new wireless health technologies.

MBAN technology consists of small, low-powered sensors on the body that capture clinical information such as temperature and respiratory functions. The technology consists of two paired devices being used. One device is worn on the body (sensor) and another device is located either on the body or in close proximity.

MBAN Technology would transform patient care enabling:

A cost effective way to monitor every patient in a healthcare institution

Reliable monitoring and enabling healthcare providers a chance to identify life-threatening problems or events before they occur

Parts of MBAN spectrum to be used outside the hospital and in patients homes

The MBAN technology would provide a small lightweight and noninvasive way to continuously monitor a baby’s health, enable devices to collect health information for the elderly or those with chronic diseases, provide continuous monitoring to help prevent sudden or acute deterioration of a patient’s condition.

According to Genachowski, under the new rules under consideration, the U.S. would be the first country to allocate spectrum for MBAN devices. Greater access to spectrum could revolutionize the healthcare industry. Costs could be reduced since physicians could intervene before a patient’s condition seriously deteriorates, disposable wireless sensors would also help decrease hospital-acquired infections, and the remote monitoring of patients with CHF alone would create an annual savings of over $10 billion a year.

MBAN would also greatly help the mobile health industry consisting of mobile applications, cloud-based data management, wireless medical devices, and many more innovative solutions to increase patient engagement and improve the delivery of healthcare services. Today, almost 17 million people are accessing health data on their mobile phones in the U.S, a 125 percent increase since 2010.Mobile Health is expected to be a $2 to $6 billion industry by 2015.

The Middle Class Tax Relief and Job Creation Act of 2012 signed in February 2012 provides for a single nationwide interoperable Public Safety Broadband Network (PSBN). This network will for the first time enable police officers, fire fighters, emergency medical service professionals, and other public safety officials to communicate with each other across agencies and jurisdictions using wireless and data services as needed.

As a result of the Act, the National Telecommunications and Information Administration (NTIA) on May 16th issued a Request for Information (RFI) to begin the development of the “State and Local Implementation” grant program included in the Act. Up to $135 million is available to fund the grants.

The Act establishes FirstNet to operate as an independent authority within NTIA to ensure the design, construction, and operation of the network. FirstNet is responsible for developing nationwide standards across the network, issuing open and competitive Requests for Proposals, building, operating, and maintaining the network, but in addition, FirstNet will oversee contacts with non-federal entities.

Responders to NITA’s RFI concerned with the State and Local Implementation Grants may want to consider some of the issues and comment on:

Best practices from existing telecommunications or public safety grant programs that NTIA should consider adopting

Costs that should be eligible for funding under the grant program

Whether data gathering on current broadband and mobile data infrastructure should be considered an allowable cost

Factors that NTIA should consider in prioritizing grants to ensure coverage in rural as well as urban areas

Other possible ideas to comment on is whether to use available tools, how to address data collection needs, how grant funds should be made available, should grant funds be based on population, and should NTIA consider phasing the distribution of grant funds in the new program.

Senator Sheldon Whitehouse (D-RI) chaired the May 16th hearing for the Health Education, Labor, and Pensions (HELP) Committee to discuss Delivery System Reform (DSR). The hearing titled “Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line” examined healthcare improvements already being achieved through DSR efforts, and highlighted the potential of these reforms to lower costs and improve care without cutting benefits.

Dr. Al Kurose, President and CEO of Coastal Medical in Rhode Island testifying at the hearing reports that Coastal is a physician governed medical group practice founded 17 years ago in Providence now employing 91 providers and providing primary care to 105,000 patients in the state.

He discussed how experience with SCI-RI, a Multi-payer Advanced Primary Care Practice demonstration site taught the organization valuable lessons about PCMH implementation. The Medicare Shared Savings ACO and Advanced Payment Model program have also proved to be important drivers to help Coastal embrace accountable care. According to Kurose, applications to these programs are pending and Coastal is hoping to be approved for a July 1 start date.

He explained how DSR efforts have helped lower costs in the organization. “We have committed ourselves to reduce the total cost of care for our populations of patients by 5 percent by the end of 2012,” said Dr. Kurose. “Already, we can point to significant accomplishments in our efforts to reduce costs, but most of our potential has yet to be realized.”

Kurose also noted the improvements in patient services implemented by Coastal. He reports that every phone call is now answered “Hello Coastal Medical. Would you like to see a provider today?” Coastal Medical recently initiated the ‘Coastal 365” campaign to let their patients know that an office will be open where they can see a primary care physician 365 days a year.

Another witness testifying was Marcia James, Director of Provider Engagement for Human, Inc. She spoke about some of the specific DSR efforts Humana has worked on, including a pilot program with Norton Healthcare System in Kentucky that stresses accountability of measured outcomes, cost, and patient delivery.

As James told the Committee, “Already, the partnership has shown significant results with a 9.1 percent decrease in unnecessary antibiotic treatment for adults with bronchitis, a 6.1 percent improvement for diabetic testing, and 8.6 percent improvement for cholesterol management in diabetics.”

Tuesday, May 15, 2012

The importance of health IT to improve patient safety and quality was the topic at the May 9th Steering Committee on Telehealth and Healthcare Informatics panel held on Capitol Hill. Neal Neuberger, Executive Director for the HIMSS Institute for e-Health Policy and the organizer for the event, is anxious to see the convergence of health IT and quality that will greatly improve the safety needs for all patients.

As panel moderator, Don E. Detmer M.D., Medical Director of the Division of Advocacy and Health Policy for the, American College of Surgeons commented on the Institute of Medicine’s November 2011 report “Health IT and Patient Safety: Building Safer Systems for Better Care”. As he pointed out, IOM recommends making improvements to the reporting of health IT safety incidents but also the importance for monitoring of health IT products.

Senator Sheldon Whitehouse (D-RI) told the attendees that he is requesting that meaningful use be amended to also address the needs of behavioral providers in order for reimbursement to be provided. Always interested in this issue, the Senator in 2011 introduced the “Behavioral Health Information Technology Act”.

As the Senator explained, “Since mental health and behavioral providers are frozen out of meaningful use, meaningful use needs to be amended and pilots need to be initiated to address the specific needs of behavior and mental health providers.”

Also, the Senator in March 2012 released a report to the Senate Committee on Health, Education, Labor, & Pension (HELP) concerning ACA’s impact on health reform. The report details how ruling the ACA unconstitutional would hamper health IT. To further discuss the issue, the Senator is chairing the HELP committee’s May 16th hearing on healthcare delivery system reform.

Also attending the Capitol Hill event, Representative Erik Paulsen (R-MN) the Co-Chair of the Medical Technology Caucus in the House is happy to see health IT receive so much attention. He introduced “The Protect Medical Innovation Act” in 2011 (H.R 436) that would amend the Internal Revenue Code and repeal the excise tax on medical devices. He is hoping to see the medical device tax repeal effort come to the House floor in 2012.

HHS was represented on the panel, as Kevin Larsen, M.D., Medical Director for Meaningful Use, within ONC, is responsible for coordinating the clinical quality measures for Meaningful Use Certification. He told the attendees that ONC has proposed capabilities, related standards, and implementation specifications that certified EHR technology users will need to consider.

Laura L. Adams, President and CEO of the Rhode Island Quality Institute, recounted how a while back, she gave an overdose of medicine to a child in a hospital. The child almost died but fortunately did survive. She has asked herself the question many times “How did this happen?”

As she explained, before the drug was given to the child, paper records were handed around six times from person to person. This is a situation that can lead to mistakes that are often easily made since so many people are handling the information. Sometimes just one decimal point out of place can create a dangerous situation in terms of safety for the hospital staff and for the patient.

Adams overall is looking at changes that need to take place in the healthcare system. As she commented, “We can start by using HIT to improve quality—not just to measure quality. But equally important, it is vital to shift the payment system from volume to value as quickly as possible and not make payments to providers on a piecework basis. Today’s system makes it possible for the worst cardiac surgeon, primary care doctor, etc., typically to get paid the same as the best.”

Optum Health Inc, a health services company with 60 million individuals, supports 1 in 5 emergency department visits, manages programs for 1 out of every 4 Medicaid recipients, and provides for 4.5 billion electronic transactions per month reports Ted Hoy, Sr. Vice President and General Manager for Optum Cloud Solutions.

Optum Health like many others is faced with the major challenge of dealing with interoperability in today’s healthcare world. As Hoy pointed out, there are a number of factors affecting the current state of interoperability. Today, top concerns are standards and policy issues, lack of fully aligned commercial objectives, working with the new delivery models such as ACOs and medical homes, and dealing with episodic care models like bundled payments.

One of the most important requirements related to interoperability is that all information must be shared seamlessly between all stakeholders in the system. As Hoy explained, unfortunately, many EHR systems already in place are stand-alone closed applications that effectively block the flow of information and are not designed to share information more broadly across all care settings.

How health IT plays an important role part in the Bronx community was described by Eric Gayle, M.D., New York Regional Medical Director for the Institute for Family Health. He emphasized that in order to improve patient safety using IT is essential to provide point-of-care checks and reviews. Also, in the Bronx healthcare community, evidence-based alerts and specific to the patient play a central role.

Screenings are provided for colorectal screening in appropriate age groups, depression screening for the adult population, PPD screening in patients with HIV, and finger stick glucose testing in patients with diabetes plus other screening events

Maggie Lohnes, Healthcare Principal, at the Mitre Corporation, presented her comments representing HIMSS. She is Co-Chair of the HIMSS Quality, Cost & Safety Committee. She recently led the HIMSS eMeasures Recommendations Task Force. Lohnes presented the highlights included in the nine eMeasures recommendations formally sent to the HHS Secretary.

A few of the recommended highlights include developing and funding an industry-standard clinical value set library to be used for eMeasure development, developing a central portal for distribution of eMeasure specifications to easily identify, download, and monitor for changes, requiring that the eMeasure testing process include a testing site plus developing an implementation guide to be used by vendors.

The Washington State Health Care Authority is working with their State Hospital Association and physicians on a legislative mandate to reduce non-emergency use of hospital emergency departments as well as other over utilized emergency services.

The new plan to begin July 1, 2012, included in the Supplemental Budget passed April 11 by the Legislature calls for $31 million to be achieved in savings including both state and federal matching funds.

Hospitals and doctors will be encouraged to refer non-emergency patients to more efficient and effective levels of care and educate all clients about the appropriate use of emergency departments.

One of the objectives for hospitals across the state is to implement electronic health information exchanges to enable emergency department physicians and community primary care physicians to quickly share information on high emergency department patient users especially patients with drug or painkiller seeking behaviors.

Key features of the plan to start July 1 include:

·Distributing information on the appropriate use of emergency department services

·Working together to establish systems for referrals of non-emergencies to primary care providers within a 72 hour window

·Establishing protocol for feedback reports so that the state and individual hospitals can track emergency department use and services received

·Implementing guidelines around the state to identify narcotic-seeking behaviors and to share decision-making information about narcotics prescribing

·Collaborating with the state, doctors, and hospitals on issues and concerns

The Colorado Trust and the Colorado Health Foundation in a joint funding effort are providing $4.5 million to launch Colorado’s “All Payer Claims Database (APCD) a tool capable of measuring healthcare costs and utilization throughout the state. Originally, the planning phase for APCD was supported through a grant from the Colorado Trust. The additional $4.6 million in funding is going to support the development, implementation, and management of the APCD.

With the launch of the APCD, the state will join nine other states that already have similar databases in place to identify variations in costs and address disparities in price where the quality and services do not justify a higher bill.

The APCD administered by the Center of Improving Value in Health Care (CIVHC) is a secure, encrypted data warehouse that will include claims information from all commercial health insurers operating in Colorado as well as Medicaid and Medicare. Scheduled to roll out in the state by the end of 2012, this resource will enable consumers and employers in the state to compare data and make informed choices about purchasing healthcare and coverage issues.

The database will also enable hospitals and other healthcare facilities to identify high cost and often misused patient services, such as unnecessary emergency room visits, and point out where alternative care solutions can have an impact.

There are indications that thoughtful use of focused data can make a difference. For more than a decade, Mesa County’s providers and payers using claims data to identify new ways to deliver and pay for healthcare has resulted in better outcomes and lower costs for Medicare patients in Mesa County than in almost any other part of the country.

The first APCD reports scheduled to be available at the end of 2012 will prove statewide aggregated overviews of healthcare costs and utilization. As additional data comes into the APCD over the next two years, more detailed analyses of costs and quality by facility and provider type will be generated. Eventually, consumers will be able to view comparative information on a public website.

The International Society for Telemedicine & eHealth (ISfTeH) announced that the African Development Bank (AfDB) has launched a competition for innovative and sustainable Information and Communication Technology (ICT) solutions for the health sector in Africa.

Initiated by the AfDB’s Human Development Department, the eHealth Award is looking for current work ongoing in the fields of eHealth and mHealth in Africa. The objective is to encourage the production and sharing of knowledge on eHealth solutions, and then share the lessons learned via eHealth and mHealth.

Individuals, NGOs, development organizations, companies, academic institutions, and research facilities are invited to participate in the award program. The winning projects will be presented in an AfDB publication and the winners will receive an award.

The award is focused on:

Using ICT to increase access to health services, particularly for the poor and marginalized

Using ICT to increase the use of essential health service

Evaluating eHealth solutions to improve efficiency in the delivery of health services

The deadline for submissions is May 30, 2012. Submissions should be in the form of an abstract of 500 words concerning the project or projects. The abstract should detail the objective of the project, start date and end date, the designers and implementers of the project, coordination factors with government and other stakeholders, the target population and target area, expected results, and type of evaluation planned.

After the abstract is evaluated, then a short list of list of candidates will need to produce an evaluation report by October 31st 2012 of 5,000 words maximum.

Jerry Brown, Governor of California issued Executive Order B-19-12 on May 3rd requiring a partnership to be formed with the Federal government to make the California healthcare system work more cost effectively and efficiently. Today, the state is spending 80 percent of the state’s total healthcare dollars on just 20 percent of the population.

As the Governor sees the problem, the state lacks a statewide strategy for collecting, prioritizing, and sharing information to help people make informed decisions concerning their own health. California is home to innovative and leaders in healthcare, technology, research, and philanthropy and has a strong record for developing successful prevention and wellness strategies.

The Executive Order requires the Secretary of HHS to establish a “Let’s Get Healthy California Task Force”. The goal is to develop a ten year plan to not only improve the health of Californians, but also to control healthcare costs, promote personal responsibility for individual health, and establish baselines for key health indicators, identify obstacles to better care, make fiscally prudent recommendations, and establish a framework for measuring improvements.

The Executive Order also requires the Secretary to appoint the members of the Task Force and include individuals representing patients and consumers, healthcare providers, health plans, employers, community-base organizations, foundations, and organized labor. The task force is required to meet by June 15, 2012.

The Executive Order also requires a report to be submitted to the Secretary by December 2012 that sets targets to:

Sunday, May 13, 2012

The American Telemedicine Association (ATA) has sent out a Call for Action to individuals involved in the use of telemedicine to help them understand how pending legislation may affect the telemedicine field.

ATA has long supported the idea of protecting consumers from illicit online pharmacies selling medications without adequate oversight by a qualified health professional. However details in a fast moving proposal presently in congress sponsored by Senator Diane Feinstein (D-CA) and Representative Bill Cassidy (R-LA) may adversely affect the use of telemedicine when used to prescribe medicine to patients. The original language was in the proposed “Online Pharmacy Safety Act” but has been redrafted as an amendment included in a larger bill now in progress dealing with FDA.

Details in this quickly evolving bill have some alarming implications for providers of telemedicine. ATA is concerned that the language in the latest version may prohibit legitimate providers from using telemedicine to diagnose and treat patients.

The latest version of the legislation would create a federal definition of a “valid prescription” which would cover all prescriptions not just controlled substances and apply to all pharmacies. In part, in order to obtain a valid prescription, it would require that the patient have an in-person medical evaluation within the previous 24 months.

Regarding telehealth, the language requires the valid prescription to either meet a Controlled Substances Act definition requiring the patient to be at a hospital or clinic, or it can be issued by a newly defined “qualified offsite telehealth practitioner” and be based on instantaneous communication with the patient. Completion of a questionnaire and/or a phone call would not be a sufficient basis for a prescription to be made available to a patient.

ATA is requesting that if you are interested in commenting on the provisions contained in this bill and potential adverse consequences on the practice of telemedicine, please contact your Senators and Representatives. For a list of Senators and Representatives, go to http://thomas.loc.gov/.

The CMS Innovation Center announced that 26 Health Care projects funded through ACA for $122.6 million will support innovations that will save money, deliver high quality medical care, and enhance the healthcare workforce. Several of the projects specifically involve the use of telehealth and telemedicine.

George Washington University received $1,939,127 for one of the projects. The project will use telemedicine to offer real-time, continuous, and interactive health monitoring to improve patient safety and treatment.

The funding will train a dialysis nurse workforce to provide care coordination utilizing team-based care, telemedicine, and the use of remote patient data to guide treatment for co-morbid, complex patients.

This approach is expected to improve patient access to care, adherence to treatment, ability to self- manage, produce better health outcomes, and reduce the cost of care for peritoneal dialysis patients with complex healthcare issues.

A project at Emory University’s Center for Critical Care, received $10,749, 332 to partner with Philips Company, a tele-intensive care unit contractor along with several other medical centers. The funding will be used is to hire more than 40 critical care professionals to be trained in the use of teleICU services with the goal to reach and help an additional 400 clinical, technical, and support professionals in underserved and rural hospitals in Northern Georgia.

The project will serve over 10,000 Medicare and Medicaid beneficiaries and will work to deal with the lack of critical care doctors in the region, improve access to quality healthcare, and lower the costs associated with not only inefficient care but also address the lack of transport services. This project could save perhaps as much as $18.4 million over a period of 3 years.

On May 7th, USDA’s Rural Utilities Service (RUS) issued funding notice (RDRUS-CC-2012) for their FY 2012 Community Connect Grant program. The program serves rural communities where broadband service is least likely to be available but where it can make a tremendous difference in the quality of life.

Funds may be used to build broadband infrastructure and establish a community center to offer free public access to broadband for two years. The estimated total program funding is $10,372,000 with an award ceiling of $1,500,000 and award floor of $100,000. Grant applications are due June 18, 2012.

Applicants eligible to apply include state, county, city or township, Native American tribal governments, nonprofits, for profits, and small businesses.

Webinars will be held on May 14th and May 24th to discuss the program. To preregister for one of the webinars, contact Nicole Payne or Carla Johnson at (202) 720-2281 or 202-720-0667 or by email Carla.Johnson2@wdc.usda.gov. Go to http://www.grants.gov/ for more information on the funding notice.

The grant funding has impacted lives in one rural area for the residents living in the Olympic Peninsula in Mason County Washington surrounding Hood Canal. This rural community until the last few years had no access to high speed internet. Topographically unique, the area is surrounded by bodies of water, dense forests, and steep terrain posing construction challenges.

The community is also home to the Squaxin and Skokomish Tribes but recently population and industry growth has created even more need for improved broadband infrastructure. Economic development primarily stems from forestry but the area has been severely impacted by the current economic downturn.

Through the years since 1978, the local phone company called Hood Canal Communications received loans and Community Connect grants from RUS and worked to improve communication services in the area.

In 2010, Hood Canal Communications received a loan of $904,000 and a grant for $2.7 million under ARRA’s Broadband Initiatives Program (BIP) to expand services to the Squaxin Tribal Community and several other areas in rural Mason County.

As a result of their partnership with Hood, the Squaxin Tribe has been able to eliminate all costly T-1 lines, replace multiple phone systems with a single integrated system, and offer seamless phone service between all tribal offices, businesses, and recreational facilities.

A state of the art video communications center was created for the Squaxin Tribe enabling the tribal community to become more competitive in the global marketplace. The computer center provides an online GED study program as well as several adult educational opportunities including computer training.

Tribal law enforcement connects with Mason County public offices and law enforcement agencies for file sharing and to access fingerprint databases. Also, the Tribe’s medical office now connects to both the medical library and the hospital information system in Portland Oregon.

Arthropods such as mosquitoes, spiders, ticks, mites, centipedes, and many other kinds of bugs can potentially cause serious diseases. Research is ongoing at the U.S Army Medical Research and Materiel Command’s Military Infectious Disease Research Program (MIDRP) to study how to protect against serious diseases caused by bugs.

For years, the research teams at the Walter Reed Army Institute of Research, Army Medical Research Institute of Infectious Diseases, Naval Medical Research Center, and at laboratories throughout the world, in coordination with MIDRP in doing research and have developed the “Arthropod Vector Rapid Diagnostic Device or AV-RDD.

The AV-RDD is a hand held device used to determine whether arthropods such as sand flies and mosquitoes are infected with pathogenic organisms capable of infecting deployed military personnel. The purpose for the device is to identify areas in which arthropod-borne diseases are present, so that commanders can determine which steps to take to either control the arthropods with pesticides or trapping, or mandate the use of personal protective measures. The device can be used anywhere at any time, simple to use, and provides results in less than half an hour.

“The AV-RDD products developed by the USAMRMC are unique in that they can identify if an arthropod is infected with a pathogen that may cause severe disease in humans,” said Monica O’Guinn, a senior biomedical scientist on the MIDRP team.

So far, five AV-RDD tool kits have been completed and able to detect Malaria, West Nile virus, and Rift Valley Fever virus, as well as a combination of viruses such as West Nile, St. Louis encephalitis, and Western and Eastern Equine encephalitis. An AV-RDD has also been developed for Dengue and for Leishmania.

To establish how effectively they work, the AV-RDD kits have been tested in both Army and Navy laboratories and evaluated at USAMRMC and NMRC field sites in Thailand, Peru, Indonesia, and Kenya. These tool kits have been endorsed for use by the Armed Forces Pest Management Board.

Key research reports:

Federal Agencies - Revised for 2012: More than 25 government agencies provide grants and contracting opportunities in telemedicine, telehealth, and health IT. What programs are getting funded? Find out in this new 260-page report. Learn more.

Includes FREE bonus report: How to Sell to HHS: This beginner's guide will help you navigate the complex federal marketplace, find agency contacts, and write a winning proposal. Learn more.